Introduction– Psychologists have a moral and professional obligation to explore the usefulness of alternative non-pharmacological treatment modalities with the patients that they see and treat. There are now a number of alternative treatment modalities available that clinicians can prescribe for their patients either as an alternative or adjunct to conventional pharmacological treatments. Exercise has been proven to be as useful as anxiolytics and antidepressants for alleviating mild to severe forms of anxiety and depression that often co-occurs. Berger & Owen (1998) and Doyne, Ossip-Klein, Bowman, Osborn, McDougall-Wilson, & Neimeyer (1987), have proven that various forms of exercise can be useful in reducing anxiety and depression. One question however that still needs to be decided is which form of physical training exercises might be best for the treatment of certain forms of DSM-5 diagnosable conditions?
Literature review– (Martinsen ,1989A, 1989B & Doyne et al.) compare aerobic to non-aerobic exercise while Berger & Owen compare four different exercise modes. There is no consistent agreement however in regard to the most effective mode. More importantly, the neurophysiological chain of events that lead to the repair and re-creation of formerly degraded neurotransmitters as a result of such diagnosable conditions as PTSD, GAD, unipolar and bipolar depression, as well as such psychotic disorders as schizophrenia through regular physical exercise needs to be more fully explored and understood by both researchers and clinicians. For exercise to be fully recognized as a treatment modality for the previously mentioned conditions, the neurophysiology involved with using exercise as a means to full recovery of neurophysiologically well balanced health has to be well understood at the research level. Numerous past studies (Markoff, Ryan, Young, 1982; Coppen & Prange, Whybrow & Noguera, 1972, ; Pargman, Baker, 1980; McMurray, Berry, Vann, Hardy, Sheps, 1988; Ismail & Young, 1977; Farrell, Gates, Morgan, & Maksud, 1982; Fuxe, Hokfelt, & Ungerstedt, 1959; Gordon, Spector, Sjoerdsma, & Udenfriend, 1966; Grossman, Price, Drury, Lam, Turner, Besser, Sutton, 1984; Randford, 1982; Sutton, Young, Lazarus, Hichie, Maksvytis, 1969) have proven that the neurochemical basis for affective disorders can positively impacted by an exercise program. These same studies cited here prove conclusively not only that there is a neurological basis for improvement but map out many of the actual pathways involved. In the face of such overwhelming evidence some have speculated (either correctly or incorrectly) that the pharmaceutical industry may feel that their financial interests are being challenged through the prescribing of such alternative treatment modalities.
The 41 studies that are included in the reference section of this proposal can be separated into two main groups. The first group would be characterized as those RCTs that involving comparing an exercise program to standard drug treatment for anxiety and depression with a subset of this group being involved with RCTs that seek a determination as to which particular form of exercise might be most effective at alleviating the symptomatology of these conditions. The second major group deals with the neuropsychology of anxiety and depression as well as the neuroscience involved with the physiology of exercise. These are the two sides of the coin so to speak that form the background to years of previous research. The earliest study cited is Michael, Jr. (1957) to be followed by Cureton (1963) both of which can be considered to be foundational studies. The two most recent studies are Heinzel, Lawrence, Kallies, Rapp, & Heinzel (2015) and Stanton, Raeburn & Happell (2013).Steptoe, Kimbell, & Basford (1998) is a “naturalistic study.” Stanton, Reaburn, & Happell (2013) is a “narrative review.” The four meta-analyses are Arent, Landers & Etnier (2000); Heinzel, Lawrence, Kallies, Rapp & Heissel (2015); Mutrie & Biddle (n.d.); Yeung (1996). Kostrubala (1976) is a book that helped to popularize running in the 1970s.
Impetus for the study– Although there are some experimental studies that compare various modes of exercise (Stanton, Reaburn, & Happell, 2013; Berger & Owen, 1988;Doyne,Ossip-Klein, Bowman, Osborn, McDougall-Wilson, & Neimeyer, 1987; Martinsen, Hoffart, & Solberg, 1989), there seems to be a lack of consistent evidence supporting any particular mode as the most effective for the most commonly diagnosed clinical conditions such as anxiety disorders, unipolar depression as well as bipolar depression, as well as such serious psychotic disorders as schizophrenia where according to Martinsen (n.d.),institutionalized patients in Norway diagnosed with schizophrenia have shown marked improvement as a result of having a prescribed exercise program. A more thorough and complete understanding of the neurophysiological basis for prescribing exercise as a fully accepted treatment modality for the previously noted behavioral conditions has to be put into place if clinicians can have confidence in the reliability of such a treatment modality.
Research question– For the purposes of this study the focus will not be upon determining the neurochemical pathways involved with the alleviation anxiety and depression in a clinical sample of (n=25) subjects in an experimental group and (n=25) in the control group for a total of (N=50) participants but rather which of the three forms of exercise or combinations thereof, i.e. weight training, aerobic conditioning (running, cycling, swimming), or Yoga is most effective at alleviating anxiety and depression.
a. Ho: Exercise has no effect upon such clinically diagnosed behavioral conditions as PTSD, GAD, unipolar and bipolar depression.
b. H1: Exercise will either fully alleviate or reduce the effect of PTSD, GAD, panic disorder, unipolar and bipolar depression and can therefore be useful as an alternative treatment modality in addition to or as a replacement for prescribed psychopharmacology.
c. H2: Of the three types of exercise cited, i.e. Yoga, aerobic, and strength training; aerobic training is best based upon RCTs to be more effective than the other two for the alleviation of anxiety and depression.
Variables- The three forms of exercise cited constitute the three different levels of the IV. Co-occurring anxiety & depression as well as unipolar depression and anxiety alone represent the three levels of the DV.
A 3 X 3 Within-Subjects Factorial Design will be employed. Subjects will be recruited from membership of the Volusia/Flagler YMCAs, the psychology department at Daytona State College in Daytona Beach, Florida as well as the psychology department at the University of Central Florida’s Daytona Beach campus. All potential participants will be interviewed and briefed by the researcher prior selection. A copy of this research proposal will be submitted to the KU IRB for approval and/or revision. SPSS software will be used for data analysis. The Profile of Mood Survey (POMS) and the Beck Depression Inventory will be given pre and post treatment to each participant at each phase. Other self-report measures may be used if deeded appropriate that have consistently demonstrated a history of reliability and validity. All participants will be required to sign an informed consent form that will be included in the appendix of the research study. The participants will be briefed at that time on the specifics of the study so that all questions that they might have about their participation can be answered. Contract information will be provided by the study’s author/researcher in care there might be additional questions after the study has been completed.
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